Risk factors and precipitating events
Based upon limited and inconsistent data, potential risk factors or precipitating events for FMD include previous injury, infection, surgery, higher rates of childhood trauma, a history of sexual abuse, and major stressful life events. In an uncontrolled retrospective study of 50 patients with FMD, a physical event occurring within three months of the onset of the FMD was reported by 80 percent.
The physical events involved an injury in 11, infection in 9, a neurological disorder (ie, severe migraine, brachial neuritis, Bell’s palsy, carpal tunnel syndrome, restless legs syndrome, and pituitary hemorrhage) in 8, pain in 4, a drug reaction in 3, surgery in 3, and vasovagal syncope in 2 subjects. Symptoms fulfilling diagnostic criteria for panic attack during the physical event were present in 36 percent. These findings suggest that FMDs are commonly triggered by physical events, sometimes in association with symptoms of panic.
The nature and timing of stressful life events may influence their role as risk factors for FMD in adulthood. In a case control study that included 322 adults with FMD and over 600 controls with other psychiatric diagnoses, childhood physical or sexual abuse was reported with similar frequency between groups, but childhood bullying and drug use before age 18 years were more common among those with FMD.
In adulthood, patients with FMD were more likely to have workplace, school, or university problems compared with psychiatric controls (23 versus 7 percent), more likely to have sexual relationship problems (32 versus 23 percent), and more likely to be involved in legal disputes (7 versus 1 percent). Thus, adult relational and occupational disruption appears to be an important risk factor for FMD.